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Dental health in children improves with 'sense of coherence'

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A new study is the first to show that an intervention designed to teach children to be confident in the face of challenges can have a positive effect on their oral and dental health. The study was published online September 27 in the Journal of Dental Research.
In a cluster randomized controlled trial involving 12 schools in Khonkaen, Thailand, and 261 schoolchildren, children from the schools that participated in an intervention designed to bolster their "sense of coherence" — the ability to see life as a challenge in which coping skills can be used to deal with stressors — showed significantly better oral health–related quality of life compared with children from schools randomly assigned to a control group. The children in the intervention group also exhibited improved beliefs about the importance of healthy dental behaviors and had better gingival health than those in the control group.
"This is a hugely important study in the dental literature. While there is some evidence in dentistry of the benefits of a sense of coherence, much of this work is cross-sectional so we don't really know if sense of coherence really brought about any possible change," said study coauthor Sarah R. Baker, PhD, a health psychologist at the University of Sheffield in the United Kingdom in an interview with Medscape Medical News. "Our study is the first intervention study to show that altering sense of coherence can influence oral health," she said.
In the study, 12 different primary schools were randomly assigned to the intervention group (n = 6 schools) or the control group (n = 6 schools). Fifth graders, aged 10 to 12 years, participated. Students assigned to the intervention group received 7 sessions over 2 months focused on child participation and empowerment. Each session lasted 30 to 40 minutes. The first 4 sessions were classroom-based activities, involving didactic learning, games, and discussions. The last 3 were health-related school projects that included all students and staff, and involved brainstorming, planning, evaluation, and implementation. The intervention was delivered by 6 teachers who went through a specialized, intensive 1-day training.
At baseline and at 2 weeks and 3 months after the intervention, children in both the intervention and the control groups completed the Child Perception Questionnaire, which assesses oral health–related quality of life through oral symptoms, functional limitations, emotional well-being, and social well-being.
The researchers also administered questionnaires at baseline and at 2 weeks and 3 months after the intervention that assessed the children's beliefs about the importance of oral health and their overall sense of coherence.
At baseline and 3 months after the intervention, clinical exams also documented dental trauma, gingival health, and dental defects.
Rigorous Study
Results indicated that compared with the control group, the children who received lessons in sense of coherence had mean scores on the oral health–related quality-of-life questionnaire that indicated fewer functional limitations and other problems due to dental health 3 months after the intervention (18.53 vs 24.32; P < 0.01). Children in the intervention group also showed a greater sense of coherence than did those in the control group (mean scores, 62.8 vs 58.79; P < .01) and were more likely to rate healthy dental behaviors as important (mean scores, 21.63 vs 19.79; P < .01). More children in the intervention group than in the control group also had normal gingival health 3 months after the intervention (31.81% vs 19.51%; P < .05).
"Our study is the most rigorous to date (in terms of methodology and statistical technique) that has studied a psychosocial intervention in the field of children's oral health," Dr. Baker said. "It's the first experimental evidence that sense of coherence influences oral health," she added.
In an accompanying editorial, Gary Slade, PhD, from the University of North Carolina, Chapel Hill, noted that the new study on sense of coherence and oral health was unusually rigorous. The researchers' findings were strengthened by a powerful statistical method known as mediation analysis, which evaluates and identifies factors that were possibly responsible for the benefits seen in the study.
"One implication [of the study] is that children's gingival health and oral-health-related quality of life can be improved by a school-based intervention that targets the psychosocial determinants of oral health rather than oral health behaviors themselves," Dr. Slade writes.
Yet, Dr. Baker noted that the study had some important limitations. Because it was performed in Thailand, where teaching methods are different than in Western countries, the results might not translate to other pediatric populations, she noted. Also, whether improving sense of coherence could affect adult oral health is another unanswered question, she said.
"The cost implications of doing an intervention chair-side and one-to-one in a dentist's office for adults would be cost prohibitive," Dr. Baker said. "And one-on-one interventions would not have the social and team interaction of the program we designed for our study of schoolchildren," she said.
The study was funded by the Royal Thai Government, Ministry of Public Health, Thailand. The study authors and Dr. Slade have disclosed no relevant financial relationships.

J Dent Res. Published online September 27, 2012. Abstract 

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